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What should I do if I suspect fraud?
What should I do if I suspect fraud?

If you suspect a third-party agent has fraudulently claimed your client’s application as their own, read here.

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Written by Lauren DiFilippo
Updated over a year ago

If you and your client suspect a third-party agent has fraudulently claimed your client’s application as their own and you have documented consent from your client, please encourage your client to report the suspected fraud to the plan issuer and to their state department of insurance (DOI). In addition, follow the guidance below to inform CMS and the NAIC (National Association of Insurance Commissioners):

  1. Email the CMS Agent/Broker Email Help Desk: If you’re aware of others conducting a search for consumer applications using approved DE/EDE websites, enrolling consumers, making unauthorized changes to consumer applications without their explicit consent, or inappropriately accessing CMS systems, report it to the Agent/Broker Email Help Desk at FFMProducer-AssisterHelpDesk@cms.hhs.gov. Include FFM App ID and Agent NPNs for reference. Avoid including Personally Identifiable Information (PII).

  2. Report to NAIC (National Association of Insurance Commissioners here, as well as the state Department of Insurance for your state.

  3. Report directly to the HealthSherpa Fraud Prevention Unit by emailing fraud_prevention@healthsherpa.com or calling (855)-977-0525.

Please be diligent and provide accurate, relevant information while reporting and make sure to follow privacy and confidentiality guidelines. HealthSherpa Agent Support is available by phone (888-684-1373), email (agent_support@healthsherpa.com), and chat if further questions arise.

For more information from CMS, read:

What type of verification or consent do I need to obtain from clients when assisting with Marketplace Enrollments?

Do I need to get a consumer’s permission before searching for or updating their Marketplace application via an approved Classic Direct Enrollment or Enhanced Direct Enrollment partner’s website?

What are proper uses of CMS systems that agents and brokers are required to abide by when accessing HealthCare.gov, the CMS Enterprise Portal, and the Direct Enrollment Pathways?

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